Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 10-10-14

10/10/2014
Prof.Dr.R.R.Deshpande
1
Snake bite,Rabies,Scorpion Bite
•Presented By –
•Prof.Dr.R.R.Deshpande (M.D in Ayurvdic Medicine & M.D. in Ayurvedic Physiology)
•www.ayurvedicfriend.com
•Mobile – 922 68 10 630
•mailme.drrrdeshpande@rediffmail.com

Special Thanks for Expertise suggestions
•Prof.Dr.Jayant Phadke – HOD ,Toxicology Dept ,Ayurved college ,Nigdi ,Pune
•Dr.Sohiel Deshpande,MBBS

God of Health = God Dhanvantari

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Snake Bite
•Toxic Snakes
•1) Neuro Toxic – Nag ( Cobra) & Manyar (common Krait)
•2) Haemotoxic or Vasculotoxic – Ghonas ( Russels viper ) & Furse ( Saw scaled Viper)

Cobra & common krait
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Russels viper & Saw scaled Viper
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Difference of Poisonous & Non Poisonous
Sr,No
Poisonous
Non Poisonous
1
Head Scales – Small
Head Scales – Large
2
Body scales -- Large
Body scales – small or moderate
3
Tail - Compressed
Not so
4
Nocturnal
Not so
5
Bite mark – 2 Fang marks
No fang marks
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Poisonous Snakes –Special Anatomical featurs
•1) All poisonous snakes have broad ventral plates on the belly that extend right across.
•2) All poisonous snakes have 2 fangs, which really are 2 prominent teeth besides many other small teeth.
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Poisonous & Non Poisonous – Head Scales

Poisonous & Non Poisonous - Body Scales

After bite of Snake
•1) A patient bitten by a poisonous snake will always complain of pain over the bitten area.
•2) Two fang marks are always seen. The shape of an inverted U (∩).
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After bite of Snake
•3) Bite by poisonous snake should not be considered as serious poisoning every time, because the poison glands of the snake at the time of the bite might have been empty.
•Also even a thin layer of clothing usually gives great protection.
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After bite of Snake
•4) Many times fright and panic leads to fainting.
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Watch Symptoms
•1) Elapids Neurotoxic – Cobra or Krait
•Local – Mild Burning ,Triple Response i.e redness, swelling,inflammation
•Systemic – Vomiting, Giddiness, Ptosis ,Difficulty in speaking & swalowing, Staggering gait ,Difficult respiration, Difficulty in motor Activities like hand & leg movements, spreading paralysis ( ascending from lower limbs), convulsions ,death may results within minutes or several hours due to respiratory failure

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Watch Symptoms
•2) From Russell’s & saw scaled Vipers - Haemotoxic Symptoms – Local symptoms are more severe like Intense pain,swelling,Cellulitis,Ozzing of bloody serum & formation of blisters & necrosis
•Systemic – Vomiting, Unconsciousness, Intravascular haemolysis, Epistaxsis, Haematuria, Haemetemesis, Bleeding under skin like Petechiae, Bleeding from orifices ,Hypotension.Death result from cardiovascular shock or renal failure

2 types of Snake Poison
•3 stages can be seen in Paralytic Type
•Stage 1 – Ptosis
•Stage 2 – Difficulty in Swallowing
•Stage 3 – Difficulty in Respiration , Paralysis

2 types of Snake Poison
•Haemolytic Type
•Local swelling around the bite appears quickly
•Blood collected in bulb does not clot

Signs of Poisoning
•2 puncture marks ,3/4th to 1 cm apart can be of Poisonous snake bite

When person can die ?
•1) After bite of Elapidae –20 min to 6 hrs
•2) After bite of Viperine – 2 to 4 days
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Snake Bite Management
•1) Snake bites should be treated as wounds. Antibiotics is given for secondary infection and Inj. Tetanus toxoid.
•2) If the patient is completely alright 6-8 hours after the bite, he is usually out of danger.
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•To Slow the absorption and spread of the poison:
•1) Patient is prevented from walking. Bitten limb is immobilized, preferably in a splint.
•2) Strip of cloth or handkerchief or a rubber tourniquet should applied a few cms. above the bitten area. Be released every 15 minutes for a period of one minute.
•3) Tourniquet should not be too tight .It is just to occlude venous & lymphatic return
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•4) Ice should be applied to and around the bitten area.
•5) Immobilize the part .Because movements can cause more absorption of poison

•4) The wound and the incision can be washed with very dilute solution of potassium permanganate.
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•When there are No signs of Poison –
•Tab Diazepam – 1 tab stat as a Tranquilizer
•Tab Paracetamol – As Analgesic

Wait & Watch for min 6 hours
•Look following signs of Poisoning
•1) Ptosis
•2) Local swelling
•3) Dysphagia
•4) Difficulty in breathing

•In Paralytic Type –
•If Ptosis or Dysphagia develops ,take immediate action
•If GP & do not have ASV – shift to appropriate hospital
•Respiratory Paralysis is an Emergency

•Neutralize the poison by --
1)Injection of anti venom. Most effective if administered within 1 to 4 hours of the bite.
2) Old Thought -- Sensitivity tests must be done. If the patient is not sensitive, 5cc. of the serum should be injected locally around the wound. Avoid local infiltration into a finger or a toe
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•ASV vial contains powder. Dissolve in 10 ml of sterile water for injection.
•Give ½ cc IV as Test Dose .Watch for 2 min for Urticaria
•If no allergy ,inject Full dose
•New Thought in 2014 -- Sensitivity tests are no longer recommended because they are unreliable and may even lead to sensitisation of patient before the actual therapeutic dose.

Snake Venom Antiserum
•Manufactured by Vins Bioproducts Limited Survey no 117 Thimmapur (V) 509325,Kothur (Mandal) ,Mahaboobnagar ( Dist) ,Andhra Pradesh,India

•Each 1 ml of has capacity of specifically neutralising the venom of following species of Snake
•O.60 mg of dried Indian Cobra venom
•0.45 mg of dried common Krait Venom
•0.60 mg of dried Russell’s viper venom
•0.45 mg of dried Saw scaled Viper

•Reconstituted antivenin is administered as soon as possible ,if clear cut signs or symptoms of envenomation are evident

•It can be administered in 2 ways
•1) Intravenous injections – Reconstituted antivenin is administered by slow intravenous injection ( 1 to 2 ml per minute)
•2) Infusion – Reconstituted antivenin is diluted in isotonic saline or glucose solution ( 5 to 10 ml per kg body weight)

•At present there is no simple method to measure the amount of circulating venom in the body.
•So dose of Antivenin can not be accurately recommended
•The dose also depends on the type of snake bite & severity of envenomation

•Presentation – Snake venom antiserum IP is supplied as freeze dried powder in glass vials .Sterile water for Injection IP is supplied in 10 ml vials
•The antivenin is also supplied as 10 ml liquid in glass vials

•Disposal – Left over antivenin & used empty vials should be discarded as biomedical waste

•2 vials are usually injected directly by IV route slowly ( 1 to 2 ml per minute) & taking care of sensitivity reaction
•2 more vials are given after half an hour to one hour ,if the symptoms of envenomation persists.
•Further dose can be given with IV fluids,till envenomation symptoms subside

•The patient should be closely monitored for 2 hours
•Local administration of antivenin in or around the bite site is ineffective ,painful & may raise intra compartmental pressure particularly in digits .So not recommended

•Antivenin Reactions – Anaphylaxis is life threatening .
•Anaphylaxis can be rapid onset & can deteriorate into a life threatening emergency very quickly
•Patient should be monitored closely & at the first sign of any of the following ,anti venin should be discontinued

•Anaphylaxis –
•Indicating signs & symptoms – Urticaria, Itching, fever, chills or rigors, vomiting, diarrhoea, abdominal cramps, Tachycardia, Hypotension, Bronchospasm, angioedema.

•Anaphylaxis – 0.5 mg of 1: 1000 Adrenaline IM
•Children – Adrenaline IM – 0.01 mg/kg body weight

•Anaphylaxis – To provide longer term protection against Anaphylactoid reaction ,100 mg of Hydrocortisone & 10 mg of H1 antihistamine ,IV
•Children – 0.2 mg/kg of Anti histamine IV & 2 mg /kg of Hydrocortisone IV

•Anaphylaxis – If the condition is worsening ,a second dose of 0.5 mg of Adrenaline 1:1000 IM ,may be given

•Inj ASV 1 to 4 vials ,slow IV
•Then 1 vial ,every 15 to 30 min ,till the signs start reversing
•Inj Atropine 2 amp IV ,to control excess salivation
•Inj Neostigmine 4 amp IV

•Associated Treatment – Pain – Paracetamol
•Aspirin or other NSAIDS should not be given – can excerbate bleeding
•For severe pain – mild opiates – Tramodol 50 mg
•Neostigmine is Anti cholinesterase drug – prolongs the action of Acetylcholine – revert respiratory failure & Neurotoxic symptoms – 0.5 mg IM ,half hourly + 0.6 mg of Atropine IV ,over an 8 hour period by continuous infusion

•In Dysphagia – Continuous throat suction
•In Respiratory Paralysis – Endotracheal Intubation, Artificial Respiration
•Total 10 to 15 vials of ASV may be required in Respiratory Paralysis

•Haemolytic Type –
•Inj Decadron 2 cc IV stat
•Inj Avil 1 amp IV stat
•Inj ASV 2 to 6 vials IV slowly ( Old Thought -- AST)
•Repeat Inj ASV ,if local swelling continues to increase
•Repeat CT ,every 4 to 6 hours

•Haemolytic Type
•Inj ASV 1 vial ,if Local swelling continues to increase
•Locally -- around the site-
• Inj ASC -1 to 2 ml
•Elevation of Leg
•Application of Thrombophob ointment
•Megasulph compresses

•Haemolytic Type
•Local –
•If Oedema is very less then,
•Apply -- Elastrocrepe bandage
•After 6 hours ,remove the bandage + watch Skin
•If necessary -- Reapply

•Haemolytic Type
•When oedema becomes severe ,Skin becomes bluish black ,Circulation of toes is diminished ---
•Then to save the limb ,emergency Faciotomy incisions must be taken

•Haemolytic Type
•In advanced cases ,we must look for Haematuria, Bleeding from other sites like nose, skin, check urine output.

•Haemolytic Type --
•In cases of bleeding –
•BT is given
•When possible – Platelet Transfusion is given
•Inj Fibrinogen 300 to 600 mg IV
•Inj Heparin –if DIC [ New Thought in 2014 - Heparin is ineffective against venom induced Thrombin and should never be used]

•Haemolytic Type
•When urine out put reduces –
•Inj Mannitol 300 ml IV
•Inj Lasix 2 amp IV stat & repeat sos
•Inj Decadron 2cc IV – 6 hrly
•In Renal failure ( Urea & Creatinine level increases) – Peritoneal Dialysis is done

•After giving adrenaline 1:1000 solution I.M. ½ c.c. and antihistaminic, 30 c.c. of the serum should be added to 300 c.c. or normal saline and given as I.V. drip in 1 to 2 hours.
•[ New Thought in 2014 - Prophylactic Adrenaline should not be given as a routine]
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•Old Thought -- Patients who are, sensitive, desensitization should be done. Under the cover of adrenaline, antihistaminic and steroids, small doses are injected till 40 c.c. of serum I.M. are given.
•New Thought in 2014 -- In sensitive patients Adrenaline , Antihistaminics and steroids can be given prophylactically but ASV is always given IV only
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• Symptomatic treatment:
•1) Inj. Pethidine (not morphine) 50 mg. I.M. or Inj. Largactil 25 mgm. I.M. is given for pain.
•2) Inj. Streptopenicillin
•3) Inj. Tetanus Toxoid
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•4) I.V. steroid is given in massive doses e.g. in serious patients, 300mgm. Efcorlin I.V. to start and 200 mgm. as slow I.V. drip later.
•5) If B.P. is falling, Inj. Lomodex or glucose saline with two ampoules of Noradrenaline or 100 mgm. Inj. Mephentine is added to the bottle
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When Hospital Admission is must in Snake Bite ?
• Patients who start bleeding extensively or
• Develop blackish red urine or
•Extensive paralysis
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•Assurance – Relieve fear & Anxiety
•Clean the bite area with soap & water
•Symptomatic & General Treatment --
•Wait & watch – First just give Inj TT+ IV DNS + Antibiotics, Anti histaminics, Analgesics, Steroids, Blood Transfusion, Artificial respiration, Haemodyalysis etc .If absolute No symptoms except fear & Patient is alright ,not necessary to give ASV

Treatment of absorbed venom
•1) In Elapids – Alternate 0.6 mg Inj. Atropine & 0.5 mg Neostigmine
•In paralytic cases – Inj.Adrenaline – s/c & Inj Calcium chloride – I/M
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Treatment of absorbed venom
•2) In Vipers –
•30,000 to 40,000 Units Inj Heparin
•[Heparin not to be used]
•300 to 600 gms – Inj Fibrinogen
•Also used are fresh whole blood, Platelets or Fresh frozen plasma(FFP).
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Anti Snake Venom
•1) Powder form – ASV – By Serum Institute of India ( SII) –This is PAVS = Polyvalent Anti snake Venom Serum .Price – Rs 400/- for Powder to form 10 ml solution
•Also available Powder by Haffkine Bio Pharma ,Mumbai .10 ml .Rs 400/-

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Anti Snake Venom
•2) Liquid Form – By Bharat Company,Thane ,Mumbai.For IV – 10 ml vial .Rs.400/-

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How to Administer ASV ?
•1) Old Thought -- Test Dose – 0.01 ml by Insulin Syringe s/c --- New Thought -- Not Recommended as unreliable.
•If No Allergic reactions –
•10 ml Liquid ASV in 500 ml DNS .Speed 30 drops per min
•Constant watch in the Improvement of Symptoms or Toxic or Side effects of ASV

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ASV & Blood Test
•1) PT,BT,CT – For Viperidae ( Ghonas & Phurse ) Haemotoxic

Blood Tests
•20 WBCT : 2ml fresh venous blood collected in Glass bulb.Keep undisturbed for 20 minutes.Slightly tilt the bulb and check for clotting.
Normally the blood should have clotted by the end of 20 minutes. Repeat test after 6 hours.
•BT/CT
•Platelet count : May be decreased in viper bite.
•PT : Normal is 12-14 seconds.
•TLC/DLC : May show neutrophil predominant leucocytosis.
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Snake Bite
•Tab Pinak – Herbal Tablet
•http://www.shreebharadiayurpharma.com/tabpinak.html
•http://www.shreebharadiayurpharma.com/ studypinaksasun.html ( Study in Sassoon Hosp,Pune)
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Rabies or Hydrophobia
•Infectious disease – due to Neurotropic filtrable virus ,transmitted by the bite or lick of an infected dog
•Incubation period – 10 days to several months
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Rabies – Symptoms
•1) Premonitory – Stage lasts for 2 days .Pain & discomfort at the site of bite.Irritable even to slight noise – cause spasm of different muscles like muscles of swallowing
•2) Stage of Irritability – Spasm of different muscles ,particularly deglutition
•Can not speak or drink

Rabies – Symptoms
•2) Contd –
•Even sight of water may initiate spasm
•Muscles of Larynx etc undergo spasmodic contraction.
•Respiration becomes difficult .RR – Increased
•Cyanosis, Hoarseness of voice, Jerks become brisk
•Stage lasts for 3 days .Then Heart Failure
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Rabies – Symptoms
•3) Stage of Paralysis –
•Paralysis of different muscle groups like respiration,Heart.
•Stage lasts for few hours & then Death
•Death is inevitable
•So take immediate injection after dog bite
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Do not kill the Dog
•The dog in question should never be killed
•Rather it should be kept under observation for 10 days
•If Dog is normal & live after 5 days – Chances of Rabies are almost zero & so no worry
•If dog behaves abnormal or dies in this period ,& then if Negri bodies are found in the Brain in postmartem –Then Diagnosis is confirmed of Rabies
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When full Immunization is must ?
•Rabies is a Fatal disease
•So dog is unknown or street dog or difficult to keep watch or people killed the dog – Then Full Immunization for Rabies is must
•Do not avoid Treatment of Rabies ,because it is Fatal disease ( Death of Rabies patient is 100%)
•In Pune (MS)India ,these patients are isolated in Naidu Hospital

Catch Rabied Dog
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Rabies – Local care
•Wash the wound repeatedly with soap & flowing water for atleast 15 mins.
•Clean the wound with 70% alcohol or Iodine ( under LA)
•If CLW is small – Do not suture
•If CLW is large – Suture loosely with drain after 24 hours
•Bite wound should not be sutured during primary treatment for the fear of introducing the virus into deeper tissue.

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Rabies Management
•1) Inj Rabipur = PCEC = Purified Chick Embryo Cell Vaccine = Total 6 Injections
•1 dose Vial of Powder = 1 ml = Rs.400/-
•Inj on Deltoid
•Days = 0 – 3 – 7 – 14 – 1 month & 3 months

Rabies – Passive Immunization
•If dog bites are multiple & deep
•If dog bites on face & neck
•Then ,
•Inj Berirab P ( Immunoglobulins) – 300 IU in 1 ml amp --- 3 to 4 ml IM – Injected away from the site of Inj Rabipur
•Sr.TIG 1 ml is applied locally to the wound or infiltrated around it

Inj Rabipur
•Can be given Intradermal ,in low dose
•So more Economical
•Suggested by Dr.Anant Phadke ,Mumbai
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Intradermal schedule.
•8 site intradermal schedule.
•Sites : Deltoids, lateral thigh, suprascapular area and lower quadrant of abdomen.
•Dose : 0.1ml ID
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8 site intradermal schedule
•Schedule :
Day 0 : 0.1ml ID on 8 sites
Day 7 : 0.1ml ID on 4 sites (Deltoid & thighs)
Day 28 : 0.1ml on 1 site (Deltoid)
Day 90 : 0.1ml on 1 site (Deltoid)
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Rabies Management
•2) Human Rabies Immuno Globulins
•20 IU /KG body weight
•60 kg person = 1200 IU
•Half Dose s/c ,around wound & half dose IM
•Price --- 3500/- for 1vial contains 150 IU/ml. (By Bharat serum/ Ranbaxy)Total cost may go around 16 thousand Rs
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Prevention is better than cure
•Persons exposed to Rabid animals – Veterinary Doctors ,Workers in forestry or in slaughter houses ,research workers doing animal experiments ,rural postmen
•Prophylactic vaccine
•Inj Rabipur 1 ml on days as – 0,7,21,1 year ,then every 3 years

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Rabies seen after bite of Carnivorous Animals
•Dog,Cat ,Wolf ,Jackel

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Scropion Bite
•2 Types of Scorpion
•1) Black – 99% -- Pain is severe ,but not fatal .To releive pain – Inj.Xylocaine 2 % - around wound
•Another way – Keep KMno4 crystals on the wound & sqeeze lemon on it

Red & Black Scorpion
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Scorpion Bite
•2 Types of Scorpion
•2) Red Scorpion – found in Guhagar,Chiplun ,Kokan area of Maharashtra state of India,Pondechari
•This bite can be Fatal
•Tab Prazosin ( Minipress) – Drug invented by Dr.Bavaskar ( Actually this drug was previously used only as Anti Hypertensive )
•Dose of Prazosin –1mg stat followed by 0.25 to 0.5mg every 4 to 6 hours

Scorpion Bite
•Scorpion Venom – Neurotoxic & Haematotoxic
•Since only a small quantity of the venom is injected – mortality is very less
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Symptoms of scorpion bite
•Local – more severe than snake bite – pain,oedema & reddening
•Systemic – Nausea,vomiting,restlessness,fever,convulsions,coma,cyanosis
•The site of the bite is adentified as – Pinpoint puncture spot ,local sweating & oedema
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Treatment of Scorpion bite
•1) A tight ligature should be placed proximal to the bite.
•2) Ice should be applied around
•3) Severe pain often responds to local injection of emetine hydrochloride 30 mgm. given through the puncture made by the sting, if this is visible.
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Treatment for Scorpion bite
•If severe pain & sweating –
•Inj Fortwin or Inj Pethidine 10 mg IM or IV stat
•Inj Local Xylocaine 2 % -- Infiltrate around the site of bite
•Tab Prazopress 1 mg stat or Tab Ciplar 40 mg stat ( Inchildren Tab Prazopress 1 mg one forth to one half tab)

•Systemic Involvement –
•Profuse sweating
•Ice cold extrmities
•Priapism
•Hypersalivation
•Vomiting
•Hypertension
•Tachycardia
•Pulmonary oedema

•Note – BP ,RR –every 10 min
•Tab Prazopress 1 mg stat .Then ½ tab after 4 hrs .Then ½ tab ,every 6 hours – till systemic symptoms & signs disappear
•If pain is severe -- Inj Fortwin 1cc IM or IV
•If profuse sweating & dehydration – Inj Ringer lactate IV

•If BP > 150 / 100 – Cap Depin 5 mg sublingual .Can be repeated sos ,after ½ to 1 hour
•In Tachycardia .PR >110 /min
•Inj.Calmpose 2 cc IM or slow IV

•In Pulmonary oedema ( Breathlessness,Fine Basal Crepitions )
•Propped up position
•Oxygen
•Inj Lasix 2 to 4 amp IV stat
•Inj Efcorlin 100 mg IV stat
•Inj Aminophylline 10 ml + 25 % glucose 10 ml slow IV

•Life Threatening condition – severe Dyspnoea ,frothing through mouth
•Sodium Nitroprusside drip – till pulmonary oedema is controlled
•Inj Pruside 50 mg in 5 ml – added to 500 ml 5 % dextrose – 15 drops/min – can be increased upto 40 drops / min

•4) Alternatively, local injection of Novocaine and adrenaline around the puncture can be tried.
•5) Application of tamarind juice locally may also relieve the pain.
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Scorpion Bite
•There is no specific Antidote for scorpion poison
•Invention – by Dr.Bavaskar ,Mahad,Raigad,MS
•Prazocin – Total protection against cardiac toxicity of Scorpion bite

•Wash wound with KMno4 water
•Immobilization
•Local infiltration of Anaesthetic
•Inj. Calcium Gluconate IV – to control swelling
•Inj Atropine to avoid pulmonary oedema
•Inj Glucose, Saline & hydrocortisone
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Scropion Bite
•Scropion Venom Antiserum – Haffkine Bio pharmaceuticals cop Ltd,Mumbai .Dose is 1 vial reconstituted in 10 ml of Inj for water .If symptoms persist administer another vial after 1 hour
•Dose ---
•5–25 mL of antivenom diluted in two to three volumes of isotonic saline to be given intravenously over an hour. If there is no significant improvement, further doses of antivenom can be given (total dose of antivenom required is 30–100 mL in severe envenomation).

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Rat Bite
•Inj TT
•If Rat bite fever – Inj Penicilline G
•Dose --
•3-5 million units IV 6 hourly.
•Even in Rat bite ,better give Inj Rabipur ( Anti Rabies Injection also)

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Rat Bite

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Rat Bite

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Rat Bite Fever
•Infection caused by Spirillum Minus
•Charaterised by Relapsing Fever ,arthritis & Skin eruptions
•More common in infants
•Incubation period – 1 to 6 weeks

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Rat Bite Fever
•Clinical Features –
•Local – Site becomes swollen ,purplish in colour,Lymphadenitis,draining the part
•General – Fever with chill & rigor ,remains for 2 to 4 days
•Then afebrile for 2 to 4 days .This cycle goes on
•Headache,photophobia,nausea

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Rat Bite Fever
•Clinical Features –
•General –-
•Arthritis of 1 or more joints
•Skin rashes of reddish or purplish patches often confluent & found in extremities ,asymmetrically
•Course for – 4 to 8 weeks

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Ayurved for General Practioner
•Very very popular Book in Medical Practioners
•100 common symptoms of General Practice with causes,Investigations & Ayurvedic Treatments

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Clinical Examination
•Systemic Examination of 8 systems
•Ayurvedic Srotas Examination
•Clinical significance of Lab Tests & Radiology,USG,2D Echo

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Notes on Medicine Part 1
•Very very useful Book for all Medical Practioners
•Guidelines with causes,symptoms,Ayurvedic & Modern Treatments to treat Fever,Pain in Abdomen & Arthritis

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Best Book for Medical Students & Practioners

Preventive Cardiology & Ayurvedic Management
•Best Book for GP
•All cardiac problems like Hypertention,CCF,
Angina,Myocardial Infarct are discussed with Ayurvedic Management
Contact -922 68 10 630
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Digestive Problems & Ayurvedic Management
•Best Book for GP
•All Digestive problems like Acidity,Pain in abdomen,
•Constipation ,colitis are discussed with Ayurvedic Management
Contact -922 68 10 630
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Gynaecological Problems & Ayurvedic Management
•Best Book for GP
•All Gynaecological problems like Heavy bleeding,White discharge,Infertility,cancer are discussed with Ayurvedic Management
Contact -922 68 10 630
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Arthritis,Backache & Ayurvedic Management
•Best Book for GP
•All Joint problems like Rheumatoid Arthritis,Osteoarthritis,Backache are discussed with Ayurvedic Management
Contact -922 68 10 630
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Neurological Problems & Ayurvedic Management
•Best Book for GP
•All Neurological problems like Headache,Epilepsy,Alzeimer’s Disease are discussed with Ayurvedic Management
Contact -922 68 10 630
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Ayurvedic Concept of Diet & Nutrition
•Best Book for GP
•Dietary Advice according to Prakruti ,Dietary prescriptions for many diseases are given
•Contact -922 68 10 630
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Prof.Dr.Deshpande’s Popular Links on Internet
•Just Start Internet on Desk top or Lap top or on your mobile . Copy Following Link & Paste as Web address –URL
•http://www.youtube.com/user/deshpande1959
•http://www.slideshare.net/rajendra9a/
•http://www.mixcloud.com/jamdadey/
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Prof.Dr.Deshpande’s Popular Links on Internet
•Just Start Internet on Desk top or Lap top or on your mobile . Copy Following Link & Paste as Web address –URL
•http://professordeshpande.blogspot.in
•http://professordrdeshpande.blogspot.in/
•http://www.mixcloud.com/rajendra- deshpande
•https://soundcloud.com/professordeshpande
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Snake Bite,Rabies,Scorpion Bite PPT – Presented By Prof.Dr.R.R.deshpande on 10-10-14

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